Lead Director, Medicare Risk Adjustment Analytics & Informatics

Hispanic Alliance for Career Enhancement; Tennessee; Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Equity program

Job summary

CVS Health is seeking a Lead Director, Informatics to steer Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and financial valuations. This role is responsible for driving risk score accuracy, regulatory compliance, and delivering data-informed opportunities.

The role is highly visible within the enterprise and will be a key contributor to strategic decision-making with senior management.

Qualifications

• 10+ years of experience in healthcare analytics, informatics, risk adjustment, actuarial, finance, data science, or related disciplines.
• 2+ years of leadership experience (direct reports, team lead).
• Advanced technical proficiency in SQL, SAS, Python, BigQuery, or similar.

Responsibilities

• Lead enterprise risk adjustment analytics supporting risk score completeness, accuracy, engagement, recapture, and algorithms.
• Lead the development and implementation of advanced predictive analytics and AI solutions.
• Partner with executive leadership and cross-functional teams to support strategic planning and performance improvements.
• Ensure adherence to CMS regulations, data governance, and compliance expectations.
• Manage data relationships with external vendors and mentor a high-performing analytics team.

Skills

SQL

SAS

Python

BigQuery

Machine Learning

Data Science

Education

Bachelor's degree

Master's degree in a related field

Tools

BigQuery

SAS

Python

Job description

CVS Health is seeking a Lead Director, Informatics to steer Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and financial valuations. This role is responsible for driving risk score accuracy, regulatory compliance, and delivering data-informed opportunities.

The role is highly visible within the enterprise and will be a key contributor to strategic decision-making with senior management.